Fundamental week 7

LO: Define and describe collaboration and teamwork. (CLO 2)

Building a nurse team → a strong nursing team world together to achieve the best outcomes for patients → effective team development requires team building and training, trust communication and a workplace that facilitates collaboration → building an empowered nursing team begins with the nurses executive → focus on change → transformational leadership → TEEAMS; Time, Empowerment, Enthusiasm, Appreciation, Management, Support, → who is the leader → it need to start from the top down → less medication errors Collaboration; is development of partnerships to chive the best possible outcomes that reflect the particular needs of the patient, family, or the community, requiring and understanding of what others have to offer → working together

LO: Recognize attributes of collaboration in the nursing profession. (CLO 2)

SBAR → a technique that provides a standardized framework for members of the health care team to communicate about a client's condition → guides individuals to speak up and express concern in a concise manner → Situation; what is happening with the client → Background; what is the clinical background → Assessment ; what do i think the problem is → Recommendation; what would i recommend

T/F Dyssomnias refers to the collection of sleep disorders

T

LO: Distinguishes non therapeutic and therapeutic communication in the nurse patient helping relationship. (CLO 2)

Therapeutic communication techniques → sharing; observation, empathy, hope, humor, feelings, → using touch, silence → providing information → clarifying -. Focusing → paraphrasing → validation → asking relevant questions → summarizing → self disclosure → confrontation NONtherapeutic communication techniques → asking personal questions → giving personal opinions → changing the subject → automatic responses → false reassurance → sympathy - pitty Empathy is not sympathy Empathy is relating; more personal → asking for explanations → approval or disapprovalm → defensive responses → arguing

what is the the difference between accountability and responsibility?

Whereas responsibility is an ongoing duty to complete the task at hand, accountability is what happens after a situation occurs. It is how a person responds and takes ownership of the results of a task.

Which statement by a nursing student demonstrates an understanding of collaboration? a. "Collaboration with patients has been used by nurses throughout the history of nursing." b. "Collaboration is a new way of interacting with physicians." c. "Collaboration is an outdated concept that has been replaced by managed care." d. "Collaboration means that the care team can make all of the decisions for the patient."

a. "Collaboration with patients has been used by nurses throughout the history of nursing."

A nurse delegates a bed bath to unlicensed assistive personnel (UAP). After lunch, the patient rings for the nurse and complains that he has not yet been cleaned up. He is very upset and angry. What should the nurse's next action be? a. Assist the patient in getting cleaned up. b. Write up the UAP for not carrying out the assignment. c.Report the UAP to the unit manager. d. Go find the UAP, and tell her to complete the bath immediately.

a. Assist the patient in getting cleaned up.

A nurse is making assignments for the day. One of the nurses just returned from medical leave due to a back injury. Which patient would be most appropriate to assign to this nurse? a. Confused, ambulatory, and requires assistance with feeding b. Recent postoperative total knee replacement patient who has not gotten out of bed yet c. Elderly, requires one-person assistance for bed-to-chair transfers d. Cerebral palsy patient with pneumonia, uses a wheelchair

a. Confused, ambulatory, and requires assistance with feeding

A nurse working in a free clinic has recognized the need for health promotion for pregnant teenagers. The nurse works to develop a consortium of healthcare experts from several disciplines across the region to work toward improving the nutrition of pregnant teenagers. This is an example of what type of collaboration? a. Interorganizational collaboration b. Intraprofessional collaboration c. Nurse-nurse collaboration d. Nurse-patient collaboration

a. Interorganizational collaboration

What strategy would be most effective in communicating with a highly anxious adult immediately before surgery? a. Providing specific, concise instructions b. Detailing likely causes of their anxiety c. Focusing on postoperative details d. Using instructional multimedia DVDs

a. Providing specific, concise instructions

Which behavior by a nurse indicates the effective strategy for collaboration with other professionals? a. Negotiates with others b. Avoids conflict c. Aggressively presents a personal view of a situation d. Strongly defends own professional role

a. Negotiates with others

Which Nursing diagnosis would be most appropriate for a patient expressing frustration with his inability to function independently following shoulder surgery? a. Powerlessness b. Social isolation c. Anxiety d. Fear

a. Powerlessness

What strategies would promote effective communication with a patient who is blind or deaf? (Select all that apply.) a. Provide adequate lighting when conversing with deaf patients. b. Stay within 3 to 6 feet while speaking to a visually impaired patient. c. Stay within 3 to 6 feet while speaking to a hearing-impaired patient. d. Utilize an interpreter to explain medical procedures to a deaf patient. e. Use light touch to arouse blind patients sleeping in a noisy environment.

a. Provide adequate lighting when conversing with deaf patients. c. Stay within 3 to 6 feet while speaking to a hearing-impaired patient. d. Utilize an interpreter to explain medical procedures to a deaf patient. e. Use light touch to arouse blind patients sleeping in a noisy environment.

What action by the nurse would most ensure accurate interpretation of patient communication? a. Providing feedback regarding the conveyed message b. Writing down the patient's conversational highlights c. Assuming significant cultural differences exist d. Verifying the patient's emotional state

a. Providing feedback regarding the conveyed message

The registered nurse (RN) on an inpatient medical unit delegates vital signs and morning care to the unlicensed assistive personnel (UAP) for five stable patients. The nurse asks the UAP to document the vital signs and report any abnormal results immediately. Which rights of delegation is the nurse demonstrating? (Select all that apply.) a. Right person b. Right circumstance c. Right time d. Right supervision e. Right patient

a. Right person b. Right circumstance d. Right supervision

The nurse is speaking to UAP about an immigrant for whom they are caring. Neither the nurse nor the UAP are familiar with the patient's culture. The UAP states, "I don't trust him. He never looks you in the eye. He must be lying about something." What must the nurse recognize in order to effectively manage the situation? a. The UAP is unaware of the cultural traditions of the patient and beliefs about eye contact. b. The UAP most likely has some good insight into this patient's behavior. c. The UAP comfort with closer social space is making the patient uncomfortable. d. The patient most likely does not feel well and just wants to rest.

a. The UAP is unaware of the cultural traditions of the patient and beliefs about eye contact.

Which statement is an example of the use of situational leadership? a. The emergency room manager takes a vote on holiday coverage and then responds to a Code Blue by directing orders at the nursing staff. b. The manager in surgery uses the vacation policy to grant time off and then performs a surgical count in an operating room using a checklist. c. A vice president of nursing allows the department directors to make a decision about a hospital policy on holiday time and then sides with a nurse who does not want to work the required time. d. The Chief Executive Officer (CEO) of the hospital instructs the nursing senate to develop a dress code and then changes the dress code after determining he does not like it

a. The emergency room manager takes a vote on holiday coverage and then responds to a Code Blue by directing orders at the nursing staff.

The nurse is having a therapeutic conversation with a patient newly diagnosed with hypertension. Which communication techniques will most likely prove effective for this patient? (Select all that apply.) a. The nurse waits until the patient has been awake for a few hours before beginning the teaching plan. b. The nurse helps the patient identify weight loss goals that are reasonable. c. The nurse gives the patient a sheet full of information and asks the patient to read the information and let the nurse know if they have any questions. d. The nurse and patient engage in a humorous conversation about the top ten "what not to eat when you are being treated for hypertension." e. The nurse presents a laminated poster to the patient that depicts pictures of foods that would be on the low sodium diet. f. The nurse states the risk factors and statistics of patients who do not take their medications as prescribed.

a. The nurse waits until the patient has been awake for a few hours before beginning the teaching plan. b. The nurse helps the patient identify weight loss goals that are reasonable. d. The nurse and patient engage in a humorous conversation about the top ten "what not to eat when you are being treated for hypertension." e. The nurse presents a laminated poster to the patient that depicts pictures of foods that would be on the low sodium diet.

Which factors influence whether a message is effectively communicated? (Select all that apply.) a.Timing of the conversation b. Educational level of participants c. Mode of communication used d. Physical environment of discussion

a.Timing of the conversation b. Educational level of participants c. Mode of communication used d. Physical environment of discussion

What is Parasomnias ?

are disruptive sleep-related disorders. Abnormal movements, talk, emotions and actions happen while you're sleeping although your bed partner might think you're awake e.g sleep walking/talking,

If a patient is grimacing, what assessment statement or question would be most beneficial in identifying the underlying cause of the nonverbal communication? a. "Did you lose something?" b. "You appear to be having pain." c. "I will turn off the lights and let you rest." d. "May I get you something to relieve your tension?"

b. "You appear to be having pain."

A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which research-based benefits should the nurse identify as likely positive outcomes of collaboration? (Select all that apply.) a. Decreased use of pain medications b. Decreased staff resignations c. Increased reimbursement from insurance carriers d. Increased patient follow-up appointments after discharge e. Decreased length of stay for patients f. Increased job satisfaction of the staff

b. Decreased staff resignations e. Decreased length of stay for patients f. Increased job satisfaction of the staff

A nurse manager is trying to improve patient satisfaction ratings for her area of responsibility. The manager meets with the staff and forms an ad hoc committee to address the issues around the problem. This is an example of what style of leadership? a. Bureaucratic b. Democratic c. Laissez-faire d. Autocratic

b. Democratic

If a patient's verbal and nonverbal communications are inconsistent, which form of communication is most likely to convey the true feelings of the patient? a. Written notes b. Facial expressions c. Implied inferences d. Spoken words

b. Facial expressions

Which of the following are examples of the planning function of management? (Select all that apply.) a. Taking action b. Goal setting c. Assessing the present situation d. Setting the plan e. Being creative

b. Goal setting c. Assessing the present situation d. Setting the plan

A staff nurse in the critical care unit routinely assists with calling staff to find coverage for the next shift and volunteers to coordinate policy and procedure revision and development on the unit. Which type of leadership is this nurse demonstrating? a. Formal b. Informal c. Laissez-faire d. Democratic

b. Informal

A nurse is volunteering in the community to educate parents to increase the number of children in the school district who are immunized. The nurse oversees the activities of a group of volunteers. Which role best describes the nurse's activity in this situation? a. Management b. Leadership c. Volunteerism d. Activism

b. Leadership

Which communication term can be applied to this statement: How messages are received and interpreted would include personal states such as mood disturbance, environmental stimuli related to the setting of the communication, and contextual variables? a. Internal noise b. Metacommunication c. Vigor communication d. Therapeutic communication

b. Metacommunication

Which defense mechanism is being exhibited when a 27-year-old patient insists on having a parent present during routine care? a. Denial b. Regression c. Repression d. Displacement

b. Regression

Which action by a nurse demonstrates an understanding of diversity factors related to proxemics? a. Assigning a male nurse to care for a young female Middle Eastern patient who needs total care b. Standing at least 18" away from English-speaking patients when discussing medical concerns c. Recognizing the need for greater personal space of people born in highly populated areas d. Acknowledging the need of teens for greater physical contact than toddlers during hospitalization

b. Standing at least 18" away from English-speaking patients when discussing medical concerns

The nurse is admitting a new patient to the psychiatric unit. Which factors will most likely contribute to a positive outcome of the interaction? (Select all that apply.) a. The patient states that he or she is in pain. b. The patient is awake, alert, and oriented to person, place, and time. c. The patient is in a bad mood. There are various interactive sessions going on in the unit today. d. The patient has been admitted to the facility in the past. e. The unit is quiet.

b. The patient is awake, alert, and oriented to person, place, and time. d. The patient has been admitted to the facility in the past. e. The unit is quiet.

During a new nurse' orientation to the unit, a nurse explains why collaboration is valued. Which outcome is a key patient care outcome that occurs when collaboration is correctly used? a. Ongoing education is not needed, because other specialties contribute to care decisions. b. There are fewer errors that occur in patient care. c. Agencies can offer higher salaries due to the cross-training of staff. d. Governmental accrediting agencies give more favorable reviews to the agency.

b. There are fewer errors that occur in patient care.

In order to effectively communicate via written e-mail with patients from an outpatient facility, a clinic nurse must implement which strategy? a. Look for visual cues. b. Verify shared information. c. Listen for voice inflection. d. Validate nonverbal signs.

b. Verify shared information.

Reticular Activating System (RAS)

brain area that plays a key role in arousal

What would be the best therapeutic response to a patient who expresses indecision about recommended chemotherapy treatments? a. "Can you tell me why you are undecided?" b. "It's always a good idea to have chemotherapy." c. "What are you thinking about the treatments at this point?" d. "You should follow whatever your health care provider recommends."

c. "What are you thinking about the treatments at this point?"

. Which statement by the nurse best promotes reflection on a patient's statement? a. "I don't quite follow what you are asking." b. "Tell me when you started having pain." c. "You seem excited to be going home." d. "Your vital signs are excellent today."

c. "You seem excited to be going home."

Which action by the nurse best demonstrates patient advocacy? a. Asking a hospitalized patient's name preference prior to care b. Fostering autonomy and independent decision making c. Arranging transportation home for a patient who is unable to drive d. Sharing evidence-based practice data with other health care professionals

c. Arranging transportation home for a patient who is unable to drive

A nurse states she believes in the dignity of each patient. At break, she is overheard talking about a patient in a persistent vegetative state as a "lump." This represents an inconsistency in which quality of an effective leader? a. Dedication b. Magnanimity c. Integrity d. Humility

c. Integrity

In relationship to a nurse's ability to communicate, effectiveness in which type of communication most demonstrates professional competence? a. Public b. Small group c. Interpersonal d. Intrapersonal

c. Interpersonal

Physical assessment of a patient requires the nurse to function most often in which area of a patient's space? a. Personal b. Social c. Intimate d. Public

c. Intimate

A nurse manager receives two vacation requests from staff for the same days off. Unit policy states that only one person may be off at a time. The manager decides to allow the staff the time off anyway. What type of leadership is the manager demonstrating? a. Democratic b. Bureaucratic c. Laissez-faire d. Autocratic

c. Laissez-faire

Which statement most closely reflects the differences between nurse leaders and managers? a. Nurse leaders are always in formal positions of authority. b. Nurse managers use transactional principles to accomplish goals. c. Nurse leaders rely primarily on interpersonal skills to accomplish goals. d. Nurse managers rely on supervisors for accountability and responsibility.

c. Nurse leaders rely primarily on interpersonal skills to accomplish goals.

Processes used in management parallel the nursing process. Which sentence describes a nurse using a management principle paralleled with the nursing process? a. Planning is demonstrated when the nurse motivates others. b. Directing is demonstrated when the nurse plans care for the patient. c. Organizing is demonstrated when the nurse coordinates care for patients. d. Controlling is demonstrated when the nurse tells other staff members what to do.

c. Organizing is demonstrated when the nurse coordinates care for patients.

A hospitalized patient experiences a sharp, stabbing pain while visiting with his spouse. Both the patient and his wife become very concerned, and the patient's call light is activated. What referent initiated communication between the patient and the nurse? a. Interaction between the patient and his wife b. Concern on the part of the patient's spouse c. Pain experienced by the patient d. Activation of the call light

c. Pain experienced by the patient

Which action by a patient indicates participation in the working phase of an effective nurse-patient helping relationship? a. Sharing of pertinent demographic data b. Exchanging of personal e-mail addresses c. Reflecting on the emotional aspects of illness d. Transitioning care to another health care provider

c. Reflecting on the emotional aspects of illness

A nurse has considered relevant patient factors such as isolation requirements, acuity, mobility, and other care needs when determining who can care for each patient. This is a demonstration of what right of delegation? a. Right task b. Right person c. Right circumstance d. Right supervision

c. Right circumstance

What action should the nurse take if an alert and oriented patient asks the nurse for personal contact information? a. Ask the patient why the personal information is needed. b. Report the interaction to the nursing supervisor immediately. c. State that it would not be appropriate to share that information. d. Change the subject, and hope that the patient does not ask again.

c. State that it would not be appropriate to share that information.

A patient does not make eye contact with the nurse and is folding his arms at his chest. Which aspect of communication has the nurse assessed? a. A message filter b. Social skills c. A cultural barrier d. Nonverbal communication

d. Nonverbal communication

When a patient with stool incontinence and significant body odor is admitted to the floor from the Emergency Department, what is the most appropriate first response of the nurse? a. Treat the incontinence episode in a matter-of-fact manner. b. Notify the ED personnel that transporting a patient in this condition is inexcusable. c. Explain how daily hygiene is important while assessing the patient. d. Assist the patient in getting cleaned up without expressing frustration.

d. Assist the patient in getting cleaned up without expressing frustration.

A patient is preparing for discharge. In discussing one of the discharge medications ordered, the patient mentions that the medication is too expensive to purchase. What action by the nurse best displays advocacy? a. Explain to the patient that the medication must be taken as ordered to work. b. Get the names of local pharmacies that offer discounted prescriptions. c. Contact the provider to schedule a follow-up appointment to check adherence. d. Contact the social worker to investigate programs to help the patient.

d. Contact the social worker to investigate programs to help the patient.

The nurse manager of a nursing unit monitors the actual number of missed medications on the unit each month and compares this number with the expected results. This is an example of which function of management? a. Planning b. Organizing c. Directing d. Controlling

d. Controlling

According to Mintzberg's 1994 model, what are the three levels of management? a. Thinking, feeling, and doing b. Planning, directing, and controlling c. Autocratic, democratic, and laissez-faire d. Information, people, and action

d. Information, people, and action

Which statement is most accurate regarding symbolic expression? a. Skills confidence can be shared most effectively by nurses through wearing distinctive clothing. b. Clothing choices by a hospitalized patient rarely reflects his or her economic resources. c. Make-up use by a patient is unnecessary for any reason during hospitalization. d. Nondramatic make-up use and minimal accessorizing by nurses demonstrates professionalism.

d. Nondramatic make-up use and minimal accessorizing by nurses demonstrates professionalism.

The nurse manager is monitoring overtime for the unit. She closely monitors staff hours and does not allow staff to come in for extra hours if they are over their allotted time per week. This is an example of which of Mintzberg's decisional roles of the manager? a. Entrepreneur b. Disturbance handler c. Negotiator d. Resource handler

d. Resource handler

You are the nurse in charge of a care team consisting of a new graduate, a male UAP, and an LPN. You are caring for a patient with renal failure and congestive heart failure. The patient is bedridden and weighs 227 kilograms (500.1 lb) and must be turned every 2 hours. In making out assignments, what is your best approach? a. Assign the patient to the new nurse so she can get experience with a large patient. b. Assign the patient to the UAP because he is a male and is stronger. c. Assign the patient to the LPN and the new RN so the new RN can perform assessments. d. Take this patient as your own assignment and assign the other staff to assist with turns every 2 hours.

d. Take this patient as your own assignment and assign the other staff to assist with turns every 2 hours.

To be effective, nurse managers should focus on which area? a. Cost-effective operation of the unit b. Motivation of staff c. Accomplishing organizational goals d. The patients and their needs

d. The patients and their needs

What is hypersomnolence?

excessive sleepiness

What is a polysomnogram?

involves the use of EEG EMG and EOG to monitor stages of sleep and wakefulness during nighttime sleep

What is insomnia?

is characterized by difficulty falling asleep, intermittent sleep or early waking from sleep, it is the most common sleep disorder

What is hypersomnia?

is excessive sleep, particularly during the day

What is bruxism?

is grinding of the teeth during sleep

What is cataplexy?

is sudden muscle weakness during intense emotions such as anger, sadness or laughter, it can occur at any time during the day

What is sleep apnea?

is the absence of breathing or diminished breathing efforts during sleep between snoring intervals. During long periods of apnea oxygen level in the blood decrease, pulse becomes irregular and b/p increases

What is sleep paralysis?

is the feeling of being unable to move or talk just before waking or falling asleep

What is narcolepsy?

is uncontrolled desire to sleep

What is nocturnal enuresis?

is urinating during sleep

What is sleep hygiene?

practices that a patient associates with sleep

What is Histamine?

promotes wakefulness, which is why antihistamine medication can make you sleepy,

Bulbar synchronizing region (BSR)

releases serotonin from the pons and medulla that produces sleep

What is OSA (obstructive sleep apnea)?

results when the airway is occluded from structural abnormalities, can be treated by an appliance called CPAP- continuous positive airway pressure, it delivers positive air pressure that holds the airway open.

What is serotonin?

which is responsible for melatonin, a hormone necessary for sleep

LO: Applies the basic elements of the communication process in: nurse-patient helping relationships, professional interactions, and health team contacts. (CLO 2)

→ Appearance, demeanor and behavior → courtesy → use of names → trustworthiness → autonomy and responsibility → assertiveness

LO: Describes the health team interdisciplinary roles, expertise, and processes that make up the team. (CLO 2)

→ a strong nursing team world together to achieve the best outcomes for patients → effective team development requires team building and training, trust communication and a workplace that facilitates collaboration → building an empowered nursing team begins with the nurses executive → focus on change → transformational leadership → TEEAMS; Time, Empowerment, Enthusiasm, Appreciation, Management, Support, → who is the leader → it need to start from the top down → less medication errors

LO: Discuss significant features and desired outcomes of nurse-health care team member relationships. (CLO 2)

→ collaboration has great potential to benefit nursing and other health professionals, strong teamwork culture promotes Job retention decreased resignation rates Improved perceptions of RN - physician communication Improved communication skills All working for the same result Patient centered Better communication

LO: Demonstrates basic group skills: communication, negotiation, and delegation and ongoing assessment of group dynamics. (CLO 2)

→ components; referent ; modivates one person to communicate to another Sender and receiver; communication/build a relationship message ; the context of the communication, clear Feedback Interpersonal variables; how we interpret the message Environment

Decision making

→ decentralized management means that decision making occurs at the level of the staff → encompasses responsibility ; duties and activities an individual is employed to perform, reflect ownership Autonomy; independent decisions about patient care Authority; legitimate power to give commands and make final decisions specific to a given position Accountability ; answerable for the actions, you own it, Know the difference between accountability and responsibility → Staff involvement Transformational leadership All staff benefit from knowledge and skill of entire work group Requires skilled communication → nursing manager supports staff through Establishing nursing practice through problem- solving committees or professional shared governance councils Interprofessional rounding Staff communication Staff education

LO: Identify ways that collaboration impacts healthcare. (CLO 2)

→ in the US healthcare system, an estimated 98,000 medical errors occur each year that lead to patient injury and death → communication is a frequently cited cause of errors in the delivery of health care → one effective communication technique is ISBARR

LO: Plan and prioritize nursing interventions designed to promote normal sleep cycles for patients in a variety of healthcare settings.

→ prepare a restful environment → promote bedtime rituals → offer appropriate bedtime snack and beverages → promote relaxation and comfort → respect normal sleep- wake patterns → schedule nursing care to avoid disturbances → use medication to prudence sleep with caution → teach about rest and sleep → consistency is key

LO: Discuss staff communication during transition of care, or transitions to different health care settings. (CLO 2)

→ respect others ideas → share information → stay informed → strive to improve you communication → share expectations of communication → use structured communication techniques → communication is key → need to stay informed

LO: Applies correct delegation principles when transferring patient tasks. (CLO 2)

→ transfers responsibility while remaining accountable for outcomes → requires knowing which skills are transferable → results in improved quality, safe patient care, improved effciency increased productivity an empowered staff and skill development of others → make sure its within their scope of practice → The five right of delegation Right task Right circumstances Right person Right direction Right supervision → is it the right task for that person for the right reason → steps to effective delegation Assess the knowledge and skills of the delegatee Match task to the delegatees skills Communicate clearly Listen attentively Provide feedback → open ended questions

LO: Discuss patient health states / communication barriers that contribute to impaired interactions. (CLO 2)

→ verbal communication; is spoken and written Vocabulary Denotative and connotative meaning Pacing Intonation Clarity and brevity Timing and relevance Language they can understand Slowly and clearly → non verbal Personal appearance Posture and gait Facial expressions Eye contact Gestures Sounds Territoriality and personal space → metacommunication